Chronic sinusitis and sinus-related symptoms are underappreciated factors which considerably impact on patient health and quality of life. They also have important societal aspects, which include economic issues but which truly resonate in the very real threat of increasing antibiotic resistance. Despite this, there is a paucity of research in this area, and physicians are left to rely upon habit, expert opinion, and extension from first principles when treating this disease.
A recent study from Little et al. published in the Canadian Medical Association Journal last month offers new evidence supporting the use of nasal irrigation in the management of chronic sinusitis.
This current study is of considerable interest as it represents the largest trial of nasal irrigation performed to date. In this “real-life” trial run by a group of general practitioners in the UK, patients with self-diagnosed sinus symptoms were recommended by their physician to use either nasal saline irrigation therapy, steam inhalation, or nothing in addition to their regular ongoing therapy. Response to treatment was assessed by asking the patients to fill out the Rhinosinusitis Disability Index or RSDI, which assesses the impact of CRS symptoms on daily life.
The findings were remarkable and clear. The simple recommendation by the physician to perform sinus saline irrigation, whether combined with steam inhalation or not, offers a measurable additional benefit to “usual therapy”, even in patients with long-standing sinus symptoms. This beneficial effect was present at three and six months following initiation of treatment, and was effective despite that patients reported using it only 60% of the time. In addition to the RSDI, significant improvements were noted in secondary measures such as increased symptom free days or doctor visits as well.
The authors have done a great service to the medical community by documenting that a simple strategy, consisting of a physician recommendation to use an inexpensive, non-toxic addition to current therapy can have a significant additional benefit on patient suffering and quality of life. While the trial is not designed to assess antibiotic use and antibiotic resistance, it is nevertheless conceivable that increased symptom free days and decreased need for physician visits should translate into lesser use of antibiotics and potential emergence of resistance as well as reduced healthcare resources. These will probably be addressed in a upcoming cost analysis performed by the same authors.
In summary, in this time of increased drug and healthcare costs, this is remarkable and would serve well to support the importance of emphasizing the use of simple, evidence-based interventions as well as more expensive technologically advanced ones.
Reference: CMAJ 2016. DOI:10.1503/ cmaj.160362. Effectiveness of steam inhalation and nasal irrigation for chronic or recurrent sinus symptoms in primary care: a pragmatic randomized controlled trial.
Authors: Paul Little MBBS, Beth Stuart PhD, Mark Mullee MSc, Tammy Thomas BSc, Sophie Johnson BSc, Gerry Leydon PhD, David Rabago MD, Samantha Richards-Hall BSc, Ian Williamson MD, Guiqing Yao PhD, James Raftery PhD, Shihua Zhu PhD, Michael Moore MSc; for the SNIFS Study Team
Prepared by: Martin Desrosiers, MD, Clinical Professor, Université de Montréal
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